I. What is coronary heart disease?
It refers to a heart disease in which the blood vessels supplying nutrients to the myocardium —– coronary arteries become severely atherosclerotic or spastic, narrowing or blocking the coronary arteries, resulting in myocardial ischemia and hypoxia or infarction.
Second, coronary heart disease, where do you come from?
High blood fat and eating a high-fat diet: a large number of cholesterol crystals in the atherosclerotic plaque
Smoking: the incidence of coronary heart disease is 2.6 times higher in a large number of smokers than in nonsmokers, nicotine can make the heart rate increase, blood pressure increase, and increase myocardial oxygen consumption
Wuhan Asian Heart Hospital Cardiology Department Su
Hypertension, diabetes, obesity and little exercise, family history, etc.
Treating the disease is better than preventing it, and taking medicine is better than quitting smoking; the earlier the age of quitting smoking, the better the prevention effect on coronary heart disease.
Third, when you have coronary heart disease, you will feel ……
Typical symptoms are exertional chest tightness, chest pain, some patients radiate to the left shoulder, left upper arm, left little finger, generally lasting 2-3 minutes or 5-10 minutes, rest or with nitroglycerin and other drugs can be relieved; severe pain is intense, lasts a long time, rest or sleep can also be seized; some patients can also be manifested as epigastric pain.
The first step
I. How to prevent and treat coronary heart disease?
Prevention of coronary heart disease
Primary prevention: It is to prevent the occurrence and development of coronary heart disease for people who do not have coronary heart disease. Improve lifestyle (reasonable diet, moderate exercise, quit smoking, limit alcohol, psychological balance); lower blood pressure; regulate lipids; lower sugar; aspirin. Current evidence-based medicine shows that aspirin is one of the most effective primary prevention measures.
1.Regular monitoring of blood pressure, blood lipids and blood sugar
2.Total cessation of smoking
3.Avoid passive smoking
4.Aerobic exercise (brisk walking)
5.Control weight
6.Rational diet
Secondary prevention: It refers to the prevention of those who already have coronary heart disease, with the aim of controlling its development, delaying or reducing the occurrence of complications, stopping deterioration, complete cessation of smoking; aerobic exercise; weight control; reasonable diet; lipid regulating treatment to meet the standard; strict control of blood sugar; anti-platelet drugs;
1), blood pressure: less than 140/90mmHg, less than 130/80mmHg in combined DM, heart failure, chronic kidney disease.
2), lipids: LDL-C below 2.6 mmol/l (100 mg/dl).
3), blood sugar: strive for HbA1c below 7.0%, FS below 6.1mmol/l and postprandial blood sugar below 7.8mmol/l.
4), BMI: less than 25, or if ≥25, waist circumference <90cm for men and <80cm for women are required.
5), exercise: no less than 5 days per week, no less than 30 minutes each time.
6), smokers must quit smoking (including passive smoking)
7), diet control; reduce total fat and cholesterol intake, increase plant sterols, dietary fiber and fish.
8), oral aspirin (75-150g/d) is required for those without contraindications, with clopidogrel substitution for those with contraindications or intolerances.
9), those with a history of MI should use ACEI class of drugs, encourage the use of this class of drugs for all CAD, and use ARB if intolerable;
10), patients without contraindications should use beta-blockers.
1, effective prevention and treatment of hypertensive disorders.
(1) regular measurement of blood pressure (2) the rational application of antihypertensive drugs to lower blood pressure to the standard
2, prevention and control of hyperlipidemia.
(1) a reasonable diet (2) drug control (must be combined with a reasonable diet) lipid standard
Food selection: choose foods with low fat and cholesterol content and foods with cholesterol-lowering effect. Such as skinless poultry, lean meat, lean fish, milk, onion, garlic, chervil, cucumber, apple, etc., cooking with vegetable oil.
3. Strictly control blood sugar: fasting blood sugar <6.1mmol/L, glycosylated hemoglobin <6.5%, postprandial 2 hours blood sugar <7.5
Postprandial 2 hours blood sugar <7.8mmol/L
The second step: treatment of coronary heart disease
I. Drug treatment
Interventional treatment
1.What is interventional therapy?
At present, the interventional techniques based on PTCA that can relieve coronary artery lesions are collectively referred to as percutaneous coronary intervention (PCI). It uses percutaneous femoral artery puncture to deliver a balloon catheter retrograde along the aorta into the coronary artery lesion site, using the mechanical effect of the pressurized filling balloon to directly dilate the atherosclerotic stenosis site, thus increasing the inner diameter of the vessel and improving myocardial blood supply to achieve the purpose of relieving and reducing the occurrence of myocardial infarction. Coronary artery stenting is the permanent placement of a metal stent in the coronary artery lesion to support the vessel wall in order to keep the coronary artery lumen open.
2.Medication guidance
Clopidogrel plus aspirin regimen can significantly reduce the incidence of postoperative thrombosis, provide early and long-term protection to patients, and reduce the risk of death, recurrence of heart disease or stroke. Therefore, it has become the standard of care for anti-thrombotic treatment after coronary stenting.
After implantation of common stents.
1.Aspirin 0.3g once daily for 1 month and 0.1g once daily for life.
2. clopidogrel 75 mg once daily for one month.
For implantation of drug-eluting stents.
1.Aspirin 0.3g once a day for 3 months, 0.1g once a day for life,
2.Clopidogrel 75mg once a day for at least 12 months.
3.Life guidance
In 1992, WHO proposed that there is no vaccine to prevent cardiovascular disease, but a healthy lifestyle is the best prevention. The four bases for maintaining a healthy heart are reasonable diet, moderate exercise, smoking cessation and alcohol restriction, and psychological balance.
1)
A reasonable diet: do not eat too much, it is advisable to have a light and diversified diet, low salt, low fat and low cholesterol diet, small and frequent meals;
2)
Make patients and their families aware of the danger of long-term hypertension and hyperglycemia, and actively treat them to control blood pressure and blood sugar at normal levels;
3)
3) Smoking increases the incidence and death rate of coronary heart disease by 2 to 6 times, so before discharge, make patients aware of its harmful effects and resolve to quit smoking or reduce the amount of smoking until the transition to complete cessation.
An out-of-hospital exercise program was developed based on the degree of preoperative and postoperative coronary artery disease, preoperative functional status, age, and exercise training during hospitalization. The main form of rehabilitation exercise is walking, which can be combined with other forms of training of equivalent intensity such as stair climbing and bicycling, all of which are non-monitored rehabilitation training. After discharge from the hospital, there should be weekly monitored rehabilitation training, and every two months after discharge, a cardiac function assessment should be performed to adjust the next home rehabilitation training program, and to determine whether restenosis occurs according to the assessment results and the presence of angina symptoms. For patients with three residual lesions or two more serious lesions after surgery, those with postoperative complications under control, those with diabetes mellitus, those who are old and in poor general condition, they should be considered as high-risk groups and adopt a low-intensity rehabilitation program. Advise patients and their families to suspend activities if they experience precordial discomfort, palpitations, shortness of breath, significant increase in heart rate, dizziness and lightheadedness after activities, fatigue, and increase or decrease in blood pressure during the rehabilitation process.
4.Psychological guidance
Modern medicine believes that coronary heart disease is a psychosomatic disease, behavior, psychological and social factors are closely related to the occurrence, development and regression of coronary heart disease, tension and mood swings can induce coronary artery spasm, increasing myocardial oxygen consumption. PCI patients have a process of adaptation to the disease after discharge, should help patients to obtain psychological support, help patients face the disease correctly, maintain a calm state of mind, so as to reduce negative emotions The patient should be given psychological support to help him/her face the disease properly and maintain a calm state of mind, thus reducing negative emotions.
5.Refresher guidance
Advise patients to seek timely medical consultation when they have discomfort in the precordial area. Especially educate the patient and family members not to stop the medication at will, take the medication on time and in accordance with the dosage, follow the doctor’s instructions for regular follow-up, check blood lipids, liver function, please fasting.
C. Surgical treatment
1.What is bypass surgery?
Bypass surgery is to use a tube taken from the patient’s body to establish a pathway between the distal end of the narrowed coronary artery and the aorta, so that the distal end of the narrowed artery can be better supplied with blood.
2.Life guidance
Nutrition/diet
Adhere strictly to low salt, low fat and low cholesterol foods as directed
Avoid foods containing palm oil and coconut oil
Limit foods rich in fat and cholesterol, such as meat, egg yolk and seafood, etc.
Use sunflower oil, olive oil and peanut oil as cooking oils
Low-salt diet
Choose fresh and frozen meats, fish and vegetables instead of cured/canned foods
Reduce the amount of salt/soy sauce you add to food when cooking
High fiber diet
Eat fresh fruits and vegetables
Eat oatmeal, beans, bran, whole wheat bread and malt
Limit alcohol consumption
Men: two glasses of wine or one can of beer per day
Women: one glass of wine or one can of beer per day
Control your weight, as excess weight can increase the burden on your heart and affect your long-term prognosis after surgery
Mobility/recovery
Continue to do lighter activities for three months after you return to normal activities
Be prepared between activities to avoid extreme fatigue
No smoking
Avoid strenuous activities such as pushing, pulling or lifting weights as well as pull-ups, sit-ups and excessive chest extensions
You can resume sex when you feel comfortable. Avoid inappropriate panting or fatigue. Consult your doctor if you have any problems
Do not play contact sports (e.g. tennis, soccer, soccer, English soccer, rugby)
People with diabetes
Need to be aware of.
Hypoglycemia symptoms: shaking, rapid heartbeat, sweating, anxiety, dizziness, hunger, loss of vision, fatigue, headache, irritability
Hyperglycemia symptoms: extreme thirst, excessive urination, dry skin, hunger, blurred vision, sleepiness, vomiting
As you always do before surgery, monitor your blood sugar levels as you always have
Gently scrub the wound area with a vigorous iodine disinfectant and allow to dry until the scabs fall off
Keep the wound area clean and dry at all times
Do not apply talcum powder, ointment, lotion, cream or ointment to the wound
Watch for signs of wound infection, such as
Fever of 38℃ and above
Redness, swelling or discharge from the wound
Continue to give chest band immobilization for three months after discharge
Care of your operated limb.
Avoid putting pressure on your limb as it can affect blood circulation.
Avoid sitting or standing in one position for long periods of time.
Elevate your limb when sitting or lying down.
Check the condition of your limb daily. If your limb swells more or becomes red, swollen or painful, please seek medical attention.
Continue to wear compression stockings for 4-6 weeks. Socks help reduce swelling. Change socks daily after bathing.
5.Psychological guidance (same as interventional treatment)
6.Refresher guidance
The following symptoms are present to seek the next step of treatment
Shortness of breath, prolonged fatigue, lack of appetite, persistent chest pain that cannot be relieved, weight gain of more than 5KG within 3 months, bradycardia or tachycardia, redness, swelling or discharge from the wound, fever, abnormal petechiae or bleeding and other severe discomfort.
Please come to our outpatient clinic for review 3 months after discharge without any special discomfort, and follow up promptly if you have any discomfort.
The third step: life guidance of coronary heart disease
1.Dietary guidance
Low cholesterol food
Strictly adhere to low salt, low fat and low cholesterol food according to the instruction
Avoid foods containing palm oil and coconut oil
Limit foods rich in fat and cholesterol, such as meat, egg yolk and seafood, etc.
Use sunflower oil, olive oil and peanut oil as cooking oil
Low-salt foods
Choose fresh and frozen meats, fish and vegetables instead of cured/canned foods
Reduce the amount of salt/soy sauce you add when cooking food
When eating out, reduce the amount of soups you eat
High fiber foods
Eat fresh fruits and vegetables
Eat oatmeal, beans, bran, whole wheat bread and malt
Limit alcohol references
Men: Two glasses of wine or one can of beer per day
Women: one glass of wine or one can of beer per day
Maintain your weight, as excess weight can increase the burden on your heart
Quit smoking: Smoking is not only a major risk factor for coronary atherosclerosis, but also an independent risk factor for worsening coronary heart disease. Smoking worsens angina and can induce an increase in blood pressure.
2.Exercise guidance
”Life is exercise”, diet is important, but exercise is also essential. Comparing two groups of people who exercise regularly with those who do not exercise for a long time, the prevalence of the former is significantly lower than the latter, while the rate of coronary heart disease in the latter is 2-3 times higher than the former. Exercise is more about consistency than intensity. Young people are more advocate of a rhythm or medium or slow, long-term adherence, repeatability of aerobic exercise. Such as doing radio exercises, tai chi, social dance, etc.. When the body moves, the pulse rate accelerates and the breathing becomes rapid. After stopping exercise, this rapid breathing should be relieved within 5 minutes. If you are still breathing rapidly within 5 minutes or have chest pain, violent dry cough, dizziness or even fainting, you should go to the hospital immediately to find out the cause.
It is necessary to gradually increase the amount of exercise, slowly to reach the required exercise intensity in a few weeks or months.
The choice of exercise is appropriate according to physical condition, interests, hobbies and their work environment and nature.
Long-term adherence.
3.Psychological guidance
Strengthen cultivation Strengthen cultivation, when things look at the big picture, more consideration for the interests of society, the collective and others, less consideration for personal interests, not to worry about gains and losses, calculating, out of the small circle of individualism, will be less worry and anxiety, more satisfaction and joy, encounter unpleasant things, will also be self-resolution. The heart is open.
More friends and confidants to talk to each other, tell each other, venting depression, eliminating loneliness and loneliness, get rid of anxiety and worry, is beneficial to maintain a happy, relaxed mood.
Change your personality To maintain a frank, generous, happy and relaxed mood, you must change the character of being competitive, impatient and aggressive, lacking patience and a sense of urgency.